2019Referral Guide

Oakland Refer by Fax1. To submit a referral, use the referral form at the

back of this guide or go to www.childrenshospitaloakland.org/referralforms

2. Fax all materials to 510-985-2202. To check on the status of a referral: 800-400-7337.

For same or next day appointment, please call the specialty department.

MD LinkWeb link: childrenshospitaloakland.org/mdlink Tech support: 510-428-3885, ext. 4357

San Francisco Refer by Fax 1. To submit a referral, use the referral form at the

back of this guide or go to www.ucsfbenioffchildrens.org/referral

2. Fax all materials to 415-353-4485. To check on the status of a referral: 877-822-4453 (877-UC-CHILD).

For same or next day appointment, please call the specialty department.

MD LinkWeb link: ucsfhealth.org/mdlinkTech support: 415-514-8790

Referring A Patient

OaklandPhone: 510-428-3043 Email: liaisons@mail.cho.org

San FranciscoPhone: 800-444-2559 Email: referral@ucsfmedctr.org

Physician Liaison Services

Specialty Care Clinic Schedules and DirectoryOaklandchildrenshospitaloakland.org/clinicschedules

San Franciscoucsfbenioffchildrens.org/specialtyclinics

Multispecialty Clinics

Brentwood OAK 1181 Central Blvd., Ste. BBrentwood, CA 94513888-530-3034

Fremont SF1900 Mowry Ave., Ste. 1Fremont, CA 94538510-794-2918

Greenbrae SF1300 S. Eliseo Dr., Ste. 204Greenbrae, CA 94904415-461-4396

Modesto SF1444 Florida Ave., Ste. 100Modesto, CA 95350209-529-1275

Oakland Outpatient Center OAK744 52nd St.Oakland, CA 94609510-428-3000

Pleasanton SF5924 Stoneridge Dr., Ste. 100Pleasanton, CA 94588925-598-3500

San Francisco Outpatient Center SF Mission Bay1825 4th St.San Francisco, CA 94158415-353-3000

San Francisco Mt. Zion SF2330 Post St.San Francisco, CA 94143415-885-7478

San Mateo SF101 S. San Mateo Dr., Ste. 205San Mateo, CA 94401650-685-8419

San Ramon OAK2303 Camino Ramon, Ste. 175San Ramon, CA 94583925-979-3470

Santa Rosa SF100 Brookwood Ave.Santa Rosa, CA 95404707-576-7557

Walnut Creek OAK2401 Shadelands Dr.Walnut Creek, CA 94598925-979-3434 (Main line)______________________________

Single Specialty Clinics

Berkeley OAK Cardiology3000 Colby St, Ste. 301Berkeley, CA 94705510-428-3300

Eureka SFIntensive Care Nursery Follow-Up Clinic525 2nd St., Ste. 300Eureka, CA 95534415-476-7324

Eureka SFCardiologySt. Joseph Hospital, Eureka2700 Dolbeer St.Eureka, CA 95501707-445-6046

Fairfield OAK Cardiology5030 Business Center Dr., #380Fairfield, CA 94534707-863-9000

Greenbrae OAKCardiology1300 S. Eliseo Dr., Ste. 204Greenbrae, CA 94904510-428-3380

Monterey SFCardiology2 Upper Ragsdale Dr., Ste. B100Monterey, CA 93940415-353-2008

Monterey SFNephrology2 Upper Ragsdale Dr., Ste. B100Monterey, CA 93940415-476-2423

Napa OAKCardiology3443 Villa Ln., #2Napa, CA 94558707-863-9000

Salinas SFCardiology1441 Constitution Blvd. Building 200, 2nd FloorSalinas, CA 93906831-755-4156

San Jose SFNeurosurgery2450 Samaritan Dr., Ste. 2San Jose, CA 95124408-356-5554

Sonora OAK Cardiology12791 Cabezut Rd.Sonora, CA 95370925-979-3200

Stockton SFCardiology415 E. Harding Way, Ste. IStockton, CA 95204209-529-1275

Ukiah SFCardiologyUkiah Valley Rural Health Center 260 Hospital Dr., Ste. 204Ukiah, CA 95482707- 463-7470

Specialty Care Clinic Locations and Phone Numbers

OAK | Please follow Oakland referral process SF | Please follow San Francisco referral process

Direct Admission 510-428-3601

Transfer Center855-246-5437______________________________

Adolescent Medicine/ Teen Clinic510-428-3387

Anesthesiology 510-428-3070

Audiology/Cochlear Implants 510-428-3344

Blood & Marrow Transplantation (BMT)510-428-3374

Cardiology 510-428-3380

Center for Child Protection 510-428-3742

Center for the Vulnerable Child510-428-3783

Clinical Nutrition 510-428-3209

Craniofacial Center 510-428-3150

Critical Care Medicine (ICU) 510-428-3302

Cystic Fibrosis Center 510-428-3305

Dermatology 510-428-3304

Diagnostic Imaging510-428-3410

Down Syndrome Clinic510-428-3226

Emergency Medicine 510-428-3240

Encore Medical Clinic 510-428-3783

Endocrinology/Diabetes 510-428-3654

Epilepsy Clinic 510-450-5656

Fetal Cardiology510-428-3380

Fetal Medicine Program510-428-3156

Gastroenterology, Hepatology, Nutrition (GI)510-428-3058

Gender Center 510-428-3654

Hematology/Oncology510-428-3372

Headache Center 415-502-1914

Hospitalists 510-428-3237

Infectious Diseases510-428-3336

Infusion Center/Day Hospital510-428-3338

International Adoption Clinic 510-428-3010

International Clinic 510-428-3226

Laboratory Services (Clinical) 510-428-3525

Laboratory Services (Pathology)510-428-3530

Medical Genetics 510-428-3550

Mental Health & Child Development 510-428-8428

Neonatology/NICU510-428-3431

Nephrology510-428-3335

Neurology510-428-3590

Neuro-Oncology510-428-3308

Neuropsychology510-428-3590

Neurosurgery510-428-3319

Ophthalmology 510-428-3050

Orthopaedics 510-428-3238

Otolaryngology (ENT) 510-428-3233

Pharmacy Claremont Ave. Clinic 510-428-4088

Pharmacy Oakland Campus510-428-3166

Plastic, Reconstructive and Hand Surgery510-428-3024

Primary Care Center 510-428-3226

Psychiatry510-428-8428

Pulmonary Function Lab510-428-3311

Pulmonary Medicine 510-428-3305

Rehabilitation (PT/OT/Speech)510-428-3655

Rett Syndrome Clinic 510-595-5458

Rheumatology510-428-3502

Sickle Cell Center510-428-3372

Sleep Disorders Center510-428-3305

Spasticity Management Clinic510-428-3655

Speech & Language Therapy Clinic 925-979-3470

Spina Bifida Clinic510-428-3655

Sports Medicine Center844-547-1800

Surgery510-428-3022

Synagis Clinic 510-428-3885, ext. 2914

Thalassemia Center 510-428-3347

Trauma Care510-428-3045

Tuberous Sclerosis Clinic510-428-3885, ext. 4543

Urology 510-428-3402

Oakland Clinic Phone Numbers

San Francisco Clinic Phone Numbers

General patient assistance888-689-8273

Adolescent/Teen Medicine415-353-2002

Allergy & Immunology 415-353-7337

Audiology 415-353-2101

Blood and Marrow Transplant415-353-2188

Brain Center855-PBC-UCSF

Cardiac Catheterization415-353-4704

Cardiology 415-353-2008

Center for Mothers and Newborns415-353-2566

Craniofacial Center 415-476-2271

Dermatology415-353-7800

Diabetes Program415-514-6234

Eating Disorders Program 415-514-1074

Emergency Department 415-353-1818

Endocrinology 415-353-7337

Fetal Cardiovascular Program415-353-1887

Fetal Treatment Center 800-793-3887

Gastroenterology and Liver Clinic415-353-2813

Gender Center 415-353-7337

Hand and Upper Extremity Surgery415-353-2808

Headache Center 415-502-1914

Healthy Hearts and Minds415-476-7324

Heart Center 415-353-2008

Hematology 415-476-3831

HIV/AIDS 415-353-2813

Imaging (Radiology scheduling)415-353-2573

Infectious Diseases 415-353-2813

Intensive Care Unit 415-353-1352

Intensive Care Nursery 415-353-1565

Intestinal Rehabilitation and Transplant 877-762-6935

Kidney Transplant 415-353-7337

Liver Transplant 415-476-5892

Medical Genetics415-476-2757

Nephrology 415-476-2423

Neurology 855-722-8273

Neurosurgery 855-722-8273

Neuro-Oncology 415-353-2986

Oncology 415-476-3831

Ophthalmology 415-353-2800

Oral and Maxillofacial Surgery415-476-3242

Orthopaedic Surgery 415-353-2967

Otolaryngology 415-353-2757

Pain Management 415-353-1328

Plastic/Reconstructive Surgery415-353-4201

Prenatal Diagnostic Center 415-476-4080

Psychiatry 415-476-7500

Pulmonology 415-353-7337

Rehabilitation415-476-3899

Rheumatology 415-353-7337

Sports Medicine Center844-547-1800

Surgery 415-476-2538

Survivors of Childhood Cancer Clinic 415-353-2986

Urology 415-353-2200

PAT I E N T I N F O R M AT I O N

Patient First Name: Last Name:

DOB: Gender:

Home phone: q Work phone or q Cell phone:

Interpreter needed: q Yes q No Language:

Parent/Guardian: Email:

Address:

City: State: Zip:

C O N S U LTAT I O N R E Q U E S T I N F O R M AT I O N

Diagnosis: ICD 10:

Reason for referral:

Include brief pertinent medical records that support the consultation: qClinical notes qGrowth Charts qImaging qLabs

R E F E R R I N G P H Y S I C I A N I N F O R M AT I O N

Referring MD: Specialty:

Phone: Fax:

Office Name:

Address: City: State: Zip:

Signature:

P C P I N F O R M AT I O N

PCP Name: Phone:

I N S U R A N C E I N F O R M AT I O N

qInclude copy of insurance card (both sides)

Subscriber Name: DOB:

Health Plan: Member ID:

Group #: Authorization #:

Secondary Insurance, if any:

By providing the information requested and signing above, you agree that we may initiate treatment following consultation or perform medically necessary diagnostics, in association with this consultation. We look forward to collaborating with you on your patient’s treatment plan.NOTICE OF CONFIDENTIALITY: This is a confidential fax and is intended solely for the person indicated above. If you are not the intended person, you are hereby notified of the confidential nature of this fax and that you are not entitled to read, copy or otherwise disseminate any of the information contained herein.

From:

Phone:

Date: No. of pages:

Fax:

Referral FormFax Oakland referrals to 510-985-2202.Preferred location: qBrentwood qGreenbrae qOakland

qSan Ramon qWalnut Creek qNext available, any location

qOther ___________________________________________________

qURGENT

Fax San Francisco referrals to 415-353-4485.Preferred location: qFremont qGreenbrae qModesto

qPleasanton qSan Francisco qSan Mateo qSanta Rosa

qNext available, any location qOther ___________________________

qURGENT

Specialty Clinic: Referred to (optional):

2019